Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
J Korean Med Sci. 2023 Oct 16;38(40):e332. doi: 10.3346/jkms.2023.38.e332.
Since the long-term outcomes of 162 patients who underwent gamma knife radiosurgery (GKS) as an initial or adjuvant treatment for acoustic neuromas (ANs) with unilateral hearing loss were first reported in 1998, there has been no report of a comprehensive analysis of what has changed in GKS practice.
We performed a retrospective study of the long-term outcomes of 106 patients with unilateral sporadic ANs who underwent GKS as an initial treatment. The mean patient age was 50 years, and the mean initial tumor volume was 3.68 cm (range, 0.10-23.30 cm). The median marginal tumor dose was 12.5 Gy (range, 8.0-15.0 Gy) and the median follow-up duration was 153 months (range, 120-216 months).
The tumor volume increased in 11 patients (10.4%), remained stationary in 27 (25.5%), and decreased in 68 patients (64.2%). The actuarial 3, 5, 10, and 15-year tumor control rates were 95.3 ± 2.1%, 94.3 ± 2.2%, 87.7 ± 3.2%, and 86.6 ± 3.3%, respectively. The 10-year actuarial tumor control rate was significantly lower in the patients with tumor volumes of ≥ 8 cm ( = 0.010). The rate of maintaining the same Gardner-Robertson scale grade was 28.6%, and that of serviceable hearing was 46.4%. The rates of newly developed facial and trigeminal neuropathy were 2.8% and 4.7%, respectively. The patients who received marginal doses of less than 12 Gy revealed higher tumor control failure rates ( = 0.129) and newly occurred facial or trigeminal neuropathy rates ( = 0.040 and 0.313, respectively).
GKS as an initial treatment for ANs could be helpful in terms of tumor control, the preservation of serviceable hearing, and the prevention of cranial neuropathy. It is recommended to perform GKS as soon as possible not only for tumor control in unilateral ANs with hearing loss but also for hearing preservation in those without hearing loss.
自 1998 年首次报道 162 例单侧听力丧失的听神经瘤（ANs）患者行伽玛刀放射外科（GKS）作为初始或辅助治疗的长期结果以来，尚无关于 GKS 实践中发生变化的综合分析报告。
我们对 106 例单侧散发性 ANs 患者行 GKS 作为初始治疗的长期结果进行了回顾性研究。患者平均年龄为 50 岁，平均初始肿瘤体积为 3.68cm（范围，0.10-23.30cm）。中位边缘肿瘤剂量为 12.5Gy（范围，8.0-15.0Gy），中位随访时间为 153 个月（范围，120-216 个月）。
11 例（10.4%）肿瘤体积增大，27 例（25.5%）肿瘤体积保持不变，68 例（64.2%）肿瘤体积缩小。肿瘤控制的 3、5、10 和 15 年累积发生率分别为 95.3%±2.1%、94.3%±2.2%、87.7%±3.2%和 86.6%±3.3%。肿瘤体积≥8cm 的患者 10 年累积肿瘤控制率明显较低（ = 0.010）。相同 Gardner-Robertson 分级的保持率为 28.6%，可利用听力的保持率为 46.4%。新发性面肌和三叉神经神经病的发生率分别为 2.8%和 4.7%。接受边缘剂量<12Gy 的患者肿瘤控制失败率较高（ = 0.129），新发面肌或三叉神经神经病发生率也较高（ = 0.040 和 0.313）。
GKS 作为单侧听力丧失的 ANs 的初始治疗方法，在肿瘤控制、保留可利用听力和预防颅神经病变方面是有益的。建议尽快进行 GKS，不仅为单侧听力丧失的 AN 肿瘤控制，也为无听力丧失的 AN 听力保护。
